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Expert opinion 2011 on the use of new anti-resorptive agents in the prevention of skeletal-related events in metastatic bone disease

Experten-Statement 2011 zum Einsatz neuer Antiresorptiva zur Prävention von Skelettkomplikationen bei Knochenmetastasen

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Summary

Bisphosphonates have been a mainstay in the treatment of cancer-related bone disease and have greatly reduced the risk of skeletal complications. More recently, clinical studies suggested additional benefits of denosumab over zoledronic acid in the prevention of skeletal related events. Similar adverse event profiles have been reported for bisphosphonates and denosumab, with infrequent occurrences of osteonecrosis of the jaw with both agents, higher incidence of renal deterioration with zoledronic acid, and higher incidence of hypocalcaemia with denosumab. Based on current evidence, the American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines do not recommend one drug class over the other in patients with metastatic bone disease. Denosumab, however, may present advantages over bisphosphonates in patients suffering from chronic renal insufficiency. Further research and growing clinical experience will refine the evidence based on which decisions in daily clinical practice can be taken.

Zusammenfassung

In der Vergangenheit waren Bisphosphonate die einzige Möglichkeit zur Vermeidung und Behandlung von Skelettkomplikationen bei ossär metastasierten Patienten. Neuere klinische Studien zeigen, dass Denosumab bei der Vermeidung von Skelettkomplikationen möglicherweise einen zusätzlichen Nutzen gegenüber Zoledronat aufweist. Für beide Wirkstoffklassen wurden vergleichbare Verträglichkeitsprofile berichtet, wobei es sowohl mit Bisphosphonaten, als auch mit Denosumab zu seltenen Fällen von Kieferosteonekrosen kam. Bisphosphonate wiesen eine höhere Inzidenz an Nierenschäden auf, Denosumab zeigte eine höhere Rate an Hypokalzämien. Basierend auf der aktuellen Evidenz, geben weder die American Society of Clinical Oncology (ASCO), noch die National Comprehensive Cancer Network (NCCN) Leitlinien zur Behandlung von ossär metastasierten Patienten eine Empfehlung zugunsten einer der beiden Wirkstoffklassen ab. Denosumab könnte jedoch gegenüber den Bisphosphonaten einen Vorteil bei Patienten mit chronischer Niereninsuffizienz bieten. Künftige Forschung und wachsende klinische Erfahrung wird die Evidenzgrundlage für klinische Entscheidungen in der Praxis entsprechend vertiefen.

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Conflict of interest

Thomas Brodowicz declares that he has received honoraria lecture fees from Amgen and Novartis and that he is a member of an advisory board of Amgen and Novartis.

Christoph Zielinski declares that he has received honoraria lecture fees from Amgen.

Roger von Moos declares that he has received honoraria lecture fees from Amgen and Roche and that he is a member of an advisory board of Amgen, Roche and Novartis.

Jindrˇich Finek declares that he has received honoraria lecture fees from Merck, Sanofi, Roche, Pierre- Fabre, and Novartis.

All other authors declare that they have no actual or potential conflicts of interest in relation to this article.

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Authors and Affiliations

  1. Institutul Oncologic Bucuresti, Bucarest, Romania

    Rodica Anghel

  2. Department of Urology, University Hospital Basel, Basel, Switzerland

    Alexander Bachmann

  3. Ankara University School of Medicine, Ankara, Turkey

    Meral Bekşac

  4. Clinical Division of Oncology and Department of Medicine I, Medical University Vienna, CECOG, Schlagergasse 6/6, 1090, Vienna, Austria

    Thomas Brodowicz & Christoph Zielinski

  5. Faculty Hospital Plzen, Plzen, Czech Republic

    Jindřich Finek

  6. General and Teaching Hospital Celje, Celje, Slovenia

    Radko Komadina

  7. Department of Chemotherapy, The Jagiellonian University Hospital, Krakow, Poland

    Krzysztof Krzemieniecki

  8. National Institute of Oncology, Budapest, Hungary

    Istvan Lang

  9. Urology Clinic, NsP Skalica, Skalica, Slovakian Republic

    Jozef Marencak

  10. Cantonal Hospital Graubünden, Medical Oncology and Hematology, Chur, Switzerland

    Roger von Moos

  11. Department of Internal Medicine, LKH Krems, Krems, Austria

    Martin Pecherstorfer

  12. Department of Oncology, University Hospital Zurich, Zurich, Switzerland

    Tamara Rordorf

  13. >University Hospital Rebro Zagreb, Medical Oncology, Zagreb, Croatia

    Damir Vrbanec

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  1. Rodica Anghel
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  2. Alexander Bachmann
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  14. Christoph Zielinski
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Correspondence to Thomas Brodowicz.

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Anghel, R., Bachmann, A., Bekşac, M. et al. Expert opinion 2011 on the use of new anti-resorptive agents in the prevention of skeletal-related events in metastatic bone disease. Wien Klin Wochenschr 125, 439–447 (2013). https://doi.org/10.1007/s00508-013-0385-4

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